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ABSTRACT
Hypertrophic cardiomyopathy (HCM), a disease formerly thought rare in clinical practice, is now believed to affect as many as 1 in 300 individuals, regardless of race or gender. Rising awareness, coupled with advanced imaging and the development of dedicated HCM centers of excellence, has led to more patients coming to clinical presentation. While some are diagnosed at a young age, others are diagnosed in middle age or well into advanced age. Unfortunately, many such patients have progressed clinically to overt heart failure, or have some combination of advanced symptoms including dyspnea, angina, pre-syncope or syncope, palpitations, and edema. Anatomic subsets, including those with mid-ventricular obstruction or apical disease, with or without apical aneurysm, have also been seen in increasing frequency. Fortunately, both percutaneous and surgical invasive options are available across the spectrum of disease severity and anatomy, with outcomes continuing to improve as the techniques and experience evolve. Advances in both approaches allow targeted and individualized treatment of the majority of these patients. This review will focus on interventional approaches to relief of obstruction, and will provide a current clinical algorithm from our center for determining when an interventional approach may be recommended or optimal over a surgical approach, and vice versa.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.